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Saturday, January 9, 2016

Physiotherapy and Elbow Pain



Asalamualaikum ,
Here the one of the most of problem for people who like to play a tennis , but it not just play a tennis will cause this pain , it is related in our lifestyle and also one of the problem come when we always do a repetitive movement without notice we injured the ligament who are attached in our elbow.
Anatomy of the Elbow
1.      Humerus
2.      Ulna
3.       Radius


 What is Muscles that cross the elbow joint:
1.      Biceps Brachii
2.       Brachialis
3.       Brachoradialis
4.       Triceps Brachii
5.       Pronator Teres, Supinator
6.       Wrist Flexors- Pronator Teres, Flexor Carpi Radialis, Flexor Carpi Ulnaris, Palmaris Longus
7.       Flexor Digitorum Superficialis, Extensor Digitorum
8.      Wrist Extensors- Extensor Carpi Radialis Longus/ Brevis, Extensor Capri Ulnaris


Tennis elbow Definition
·         “A pathologic condition of the common extensor muscles at their origin on the lateral humeral epicondyle. Epicondylitis suggests an inflammation at one of the epicondyles of the elbow.” (Dutton 419-22)
·         Tennis Elbow generally occurs in adults between the ages of 35-50. It affects between 1%-3% of the population.(Dutton 419-22)
·         Tennis elbow is typically an overuse injury. “Occupations or sports that involve repetitive grasping, with the wrist in extension, place the elbow at risk because it’s the wrist extensors that must contract during grasping activities to stabilize the wrist.”(Dutton 419-22)
·         Leads to tendonitis of the origin of the extensor carpi radialis brevis tendon.



What is the symptom appears
1.      Diffuse achiness
2.       Morning stiffness
3.      Occasional night pain
4.      Dropping of objects/ weak grip strength  
5.      Pain w/ palpation of lat. epicondyle
6.       Pain w/active or resisted extension
7.      Pain w/ grasping objects with the effected hand (Dutton 419-22)

How to trace it
Cozen’s Test

·         “Resistive Tennis Elbow Test: The patient sits with the examiner stabilizing the involved elbow while palpating the lateral epicondyle With a closed fist, the patient pronates and radially deviates the forearm and extends the wrist against the examiner’s resistance” (Sliker) A positive result would be if there is pain along the lateral epicondyle or objective muscle weakness


What are physiotherapy Intervention Techniques
1.      Flexibility exercises
2.       ROM exercises  
3.      Stretching
4.      Active assistive and resistive exercises
5.      Pain Reduction with electrotherapy
6.      Tapping and Braces

What are our goal in treating the tennis elbow
1.      Decreased pain
2.       ROM improved
3.       Joint swelling, inflammation, or restriction reduced  
4.      Muscle performance increased  
5.      Ability to perform activities is improved

Home  management and Treatment
• Rest • Ice • Anti-inflammatories (aspirin, ibuproufen, voltaren gel/ fastum gel

What are alternative treatment Intervention
1.      Deep Friction Massage
2.       Acupuncture
3.       Bracing/ Splinting
4.       Cryotherapy
5.       Strengthening Exercises
6.       Stretches
7.       Surgery
8.       
Exercises for Tennis elbow



        From my experience in treating patient who had  this problem i would like to say most properly  90% to 95% of people with tennis elbow had been improve and recover with the treatment as above described. However, about a few percentages as 5% of people will not get better with conservative treatment and their will be refered back to the specialist for second opinion and maybe  need surgery to repair the injured muscle-tendon unit around the elbow. Most of the patient who went for  surgery, it results in pain relief and return of strength after 2 month.


Wallahuaklam

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